July 21, 2010
Volume 12, Issue 15
Midwifery Today E-News
“Induction Risks”
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In This Week’s Issue:


Quote of the Week

“Women today rely on the props of drugs, machines and other people instead of relying on themselves and their bodies to do the work of labor.”

Diony Young


The Art of Midwifery

Jacuzzis to the Rescue

I attend births in a hospital where the labor and delivery unit includes jetted tubs in most of the labor rooms. Women love them. As they relax in the tub, the jets help distract them from their discomfort. Many have told me they think the “white noise” of the jets helped them shut out the outside world during labor. In addition, I love them for the nipple stimulation they can provide in a stalled labor. I just have the woman roll on her side and let a jet blow gently on one nipple. In no time at all, she has improved contractions.

Karen Wendt, CNM
Excerpted from Midwifery Today’s Sharing Midwifery Knowledge, Tricks of the Trade, Vol. IV


ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Erratum

There was an encoding problem that caused display errors for some readers of the HTML version of the July 7 issue of Midwifery Today E-News. Corrections appear below; you may view the corrected version online here: http://www.midwiferytoday.com/enews/enews1214.asp

In Jan’s Corner, the following sentences are corrected:

  • Each day, eat 80–100 grams of protein with lots of fruits and vegetables, salt your food to taste, and drink 8–12 glasses of water.
  • Those abused women tell their stories to others, and because there are so few good stories—maybe 1–2%—the cycle continues.

In Research, the following is the corrected source:

  • Checkley, W., et al. 2010. Maternal Vitamin A Supplementation and Lung Function in Offspring. N Eng J Med 362: 1784–94.

In Question of the Week Responses, the following sentence is corrected:

  • Since then we have had a few moms push 2–3 hours at home then another 2 hours in-hospital and they have had good, vaginal births there in the end, but nothing has topped that first one!

Jan’s Corner

The Accidental Good Birth

The first and most dangerous intervention is when you step over your home’s threshold to give birth. Or, maybe I should say it’s when you step inside a hospital for a normal birth, because birth centers are a great option for birth. Hospitals, it seems, are in the business of making more business. The philosophies held by many physicians and some of the nurses are pure myth. It is so sad to read the many horror stories lately as mommas send in their articles. Most times they have discovered midwives and followed up a bad experience with a good one, like I did.

I did hear a great hospital birth story this week, though. I call it the “accidental good birth.” My friend told me this story:

My friend was to accompany a young woman from our church during her birth. The young woman (I’ll call her Mary) went to the hospital in what she thought was labor, but the midwife and nurse sent her home because it was too early. Now, sending someone home is something they used to do all the time, but recently hospital staff is more likely to just admit the woman too early, induce or augment the labor, and start the “cascade of interventions.” But this blessed woman got sent home. She did this three times and was sent home each time. My friend was with her most of this time. When Mary started to get the catch in her breath that indicated possible pushing, my friend (who has four children!) knew it was really time to go. They got to the hospital and Mary had her baby about 30 minutes later. Mary is just beaming these days at church. She is happy with her baby and her birth.

Now, if we had more of those points of light working in the hospital, sending women home instead of hooking them up, wouldn’t we have a totally different birthing system? Or at least a good start! Thank you to those practitioners who work in the belly of the beast to make things better for birthing families. You know who you are, and we owe you a debt of gratitude.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan’s blog: community.midwiferytoday.com/blogs/jan/default.aspx
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International Alliance of Midwives on Facebook: facebook.com/IAMbirth


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Research

Pesticide Exposure Linked to ADHD in Children

A recent study published in the journal Pediatrics says children who have a greater exposure to pesticides, mainly through diet, are more likely to have attention-deficit/hyperactivity disorder (ADHD). The study examined ADHD levels and markers of pesticide exposure through urine samples in more than 1,100 children between the ages of 8 and 15 years. Researchers found that, as the levels of pesticides in the body increased, so did the prevalence of ADHD.

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Questioning the Widespread Use of Synthetic Oxytocin

The most common medical intervention is undoubtedly the use of drips of synthetic oxytocin. Most women who had a non-operative delivery by the vaginal route had a drip of oxytocin. Most women who had an operative delivery by the vaginal route also had hours of drip before the use of forceps or ventouse. Most women who had an in-labor c-section also had synthetic oxytocin before the decision to operate. Furthermore, the rates of labor inductions are very high in many countries and, in practice, labor induction implies hours of intravenous drip.

One should first wonder why the use of intravenous oxytocin during labor is perceived as a detail not worth mentioning in statistics. The main reason might be that the nonapeptide oxytocin is not considered a real medication because, from a chemical perspective, the synthetic form is not different from the natural hormone. Another reason might be that oxytocinases (enzymes that metabolize biologically active peptides) have been found in the placenta. This might have led to the tacit conclusion that synthetic oxytocin does not cross the placenta.

On the day when we realize that most women, all over the world, receive synthetic oxytocin when giving birth, we’ll give paramount importance to new questions, particularly about placental transfer of peptides. Paradoxically, there is only one serious published article on this issue.(1) After measuring concentrations of oxytocin in maternal blood, and also in the blood of the umbilical vein and of the umbilical arteries, and after perfusions of placental cotyledons, a team from Arkansas came to the conclusion that oxytocin crosses the placenta in both directions. More precisely, the permeability is higher in the maternal-to-fetal than in the fetal-to-maternal direction. We must add that 80% of the blood reaching the fetus via the umbilical vein goes directly to the inferior vena cava via the ductus venosus, bypassing the liver, and therefore immediately reaching the brain: it is all the more direct since the shunts (foramen ovale and ductus arteriosus) are not yet closed.

Since there is a high probability that a significant amount of synthetic oxytocin can reach the brain of the fetus, we must raise questions regarding the permeability of the blood-brain barrier at this phase of human development. Australian researchers have presented evidence that the permeability to small lipid-insoluble molecules is greater in the developing brain and that specific mechanisms, such as those involved in transfer of amino acids, develop sequentially as the brain grows.(2) Furthermore, it appears that the permeability of the blood-brain barrier can increase in situations of oxidative stress(3–5)—a situation that is common when drips of synthetic oxytocin are used during labor.(6) We have, therefore, serious reasons to be concerned if we take into account the widely documented concept of “oxytocin-induced desensitization of the oxytocin receptors.”(7–10) In other words, it is probable that, at a quasi-global level, we routinely interfere with the development of the oxytocin system of human beings at a critical phase for gene-environment interaction. In such a new situation, the priority is to phrase appropriate new questions at a cultural level—questions that would induce a new generation of research.

References:

  1. Malek, A., E. Blann and D.R. Mattison. 1996. Human placental transport of oxytocin. J Matern Fetal Med 5(5): 245–55.
  2. Saunders, N.R., M.D. Habgood and K.M. Dziegielewska. 1999. Barrier mechanisms in the brain, II. Immature brain. Clin Exp Pharmacol Physiol 26(2): 85–91.
  3. Noseworthy, M., and T. Bray. 1998. Effect of oxidative stress on brain damage detected by MRI and in vivo 31P-NMR. Free Radic Biol Med 24: 942–51.
  4. Anagnostakis, D., et al. 1992. Blood-brain barrier permeability in healthy infected and stressed neonates. J Pediatr 121: 291–94.
  5. Noseworthy, M., and T. Bray. 2000. Zinc deficiency exacerbates loss in blood-brain barrier integrity induced by hyperoxia measured by dynamic MRI. Proc Soc Exp Biol Med 223(2): 175–82.
  6. Schneid-Kofman, N., et al. 2009. Labor augmentation with oxytocin decreases glutathione level. Obstet Gynecol Int 2009: 807659. E-pub. 16 Apr 2009.
  7. Robinson, C., et al. 2003. Oxytocin-induced desensitization of the oxytocin receptor. Am J Obstet Gynaecol 188(2): 497–502.
  8. Gimpl, G., and F. Fahrenholz. 2001. The oxytocin receptor system: structure, function and regulation. Physiol Rev 81(2): 629–83.
  9. Phaneuf, S., et al. 2000. Loss of myometrial oxytocin receptors during oxytocin-induced and oxytocin-augmented labour. J Reprod Fertil 120(1): 91–97.
  10. Phaneuf, S., et al. 1998. Desensitization of oxytocin receptors in human myometrium. Hum Reprod Update 4(5): 625–33.

Michel Odent
Excerpted from "If I Were the Baby: Questioning the Widespread Use of Synthetic Oxytocin," Midwifery Today, Issue 94
View table of contents / Order the back issue


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Midwifery Today Magazine Issue 94


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Question of the Week

Q: Do you induce labor with herbs, homeopathy or other natural remedies in your practice? If you do induce, what are the reasons for the induction?

— Midwifery Today staff


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


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Question of the Week Responses

Q: What was the longest second stage you've experienced and how did mom and baby pull through?

— Midwifery Today staff

A: The longest second stage that I have witnessed as a childbirth professional was five hours. The mother was 42 weeks LMP and consented to induction by release of membranes. Labor progressed beautifully to second stage without issue. Upon being diagnosed as complete by the nursing staff and feeling the urge to push, the mother actively participated in birthing her baby. Position changes included upright, squatting, toilet, hands-and-knees, side lying and lithotomy without fetal progress past +2. About three hours into the second stage, the mother started to experience uteral pain at the placental site during each push. Epidural anesthesia was the next option, and gave the mother time to rest while her body pushed. Pitocin was started at a low drip, but the baby did not tolerate the addition of Pitocin.

A surgical birth was consented to at five hours after the start of active pushing. While the provider diagnosed cephalopelvic disproportion, the baby was found to have a short cord that went from belly, over fetal shoulder to the placenta which was at the baby’s back. The placental pain was due to the baby’s body pulling the umbilical cord down on each push, pulling on the placenta. Both mother and baby did fine. Baby tolerated the second stage beautifully until the Pitocin. This mother went on to have three VBACs! Her last baby was ounces bigger than her first baby, who was 9 lb 4 oz at birth.

— Chantel Haynes, LPN, doula, ADNS

A: My longest second stage was 7-1/2 hours. Mom had a mild hemorrhage and baby boy did just fine.

— Anne Sommers, LM
http://www.dear-midwife.com


Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Think about It

Avoiding an Unnecessary Induction

  • Refuse an elective induction, that is, an induction for convenience.
  • Refuse an ultrasound to determine fetal weight.
  • Refuse an induction for a suspected large baby.
  • Don’t permit your due date to be changed based on an ultrasound done later than 13 weeks’ gestation.

Henci Goer
Excerpted from The Thinking Woman’s Guide to a Better Birth


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